The Change Healthcare report noted that the average rate of healthcare claim denials has been up 23 percent since 2016, with 11.1 percent of healthcare claims being initially denied during the first three quarters of 2020. Covid has impacted health insurance denials, with the highest denial rates among regions with the highest first-wave of Covid-19 outbreaks, including the Pacific Coast (13 percent of claims denied on initial submission in 2020). Although some claims are denied for valid reasons, in other cases, an insurance company treating you unreasonably or unfairly is committing an act of bad faith. Should you find yourself in such an untenable situation, you could benefit from speaking to a Santa Clarita health insurance denial attorney.
When you purchase health insurance—probably after a long process of evaluating the best plan for the health needs of you and your family—you expect your health insurance will cover necessary procedures, tests, and medications. When a legitimate claim is denied, it can be challenging to fight a huge insurance company on your own.
Having an attorney who really cares about you and your health insurance denial can make a massive difference in the outcome of your situation. You have the legal right to request documentation from your insurer and take any steps necessary to pursue a bad faith case against your insurance company.
Insurance bad faith is any situation in which an insurance company violates the duty of good faith owed to policyholders—to treat them reasonably and fairly. In short, your insurance company should look just as hard for a reason to pay your claim as for an excuse to deny it. Unfortunately, this is not the case in many situations. The Law Offices of Scott Glovsky takes cases we fully believe in.
The quest to expose insurance company wrongdoing ultimately makes your life better while making the world a better place as well. Attorney Scott Glovsky is always prepared to uncover the truth, even when that means going up against a large insurance company. If your health insurance company has wronged you, remember—at the Law Offices of Scott Glovsky, we care about you and the impact an insurance denial can have on you and your family.
What are the Legal Duties of a Health Insurance Company?
Your healthcare provider has a legal obligation to treat you fairly and not take advantage of you, and this is what you expect. Your health insurance company has the legal duty to do the following:
- Ensure all the information you need is thoroughly communicated to you and delivered to you in an accurate, honest manner, with no misrepresentation of facts regarding your policy
- Investigate any claim you submit, obtaining all necessary information required to make an informed decision
- Provide a valid reason for any claim denial
- Ensure information is provided regarding the process for appealing a claim denial
- Respond to you within a specified length of time after an appeal is submitted
Why Do Health Insurance Claims Get Denied?
There are some instances in which a is warranted. The most common reasons a health insurance claim could be denied include:
- An out-of-network provider or service was used.
- The prescription drug is not a part of your health plan—or will only be paid for after you have tried cheaper alternatives.
- You have maxed out the coverage limits of your plan.
- The procedure, test, or prescription drug is not deemed medically necessary.
- There is incomplete or missing information in the claim you submitted.
When your claim has been denied, you will receive a denial notification. Within this notification, you should find the reason your claim was rejected as well as a notice that tells you how long you have to appeal the decision. You mustn’t miss this deadline. You or your attorney can write an appeal letter to have your case looked at as soon as possible. Make sure the appeal process is carefully followed if you request an appeal.
What Tactics Do Health Insurance Companies Use and How Can a Santa Clarita Health Insurance Denial Attorney Make a Difference?
Health insurance companies have found several ways to deny legitimate claims. These are just a few:
- The insurer may delay processing your claim—over and over. This is generally purposeful and is a means to wear you down to the point you give up. You could be told to fill out a form, then told you did not fill it out correctly, then told you need to fill out another form, then that your claim is late, your claim is not covered…and on and on.
- Insurance companies may simply deny the covered claim. A claim could be rejected using a tenuous interpretation of the policy language, a willful misunderstanding of the policy, or throughout and out fraud. Denying claims can have the same effect as delaying a claim—the claimant eventually gives up and drops the matter.
A denial for no valid reason is considered bad faith on the insurer’s part. If your insurance company has unreasonably denied your claim, you need to speak to an experienced Santa Clarita, CA health insurance denial attorney from the Law Offices of Scott Glovsky as quickly as possible. We deal with insurance companies day in and day out. We understand every single tactic and know the best way to counter it.
How does a Santa Clarita Health Insurance Denial Attorney from the Law Offices of Scott Glovsky Help?
When you are frustrated and angry because of the denial of your legitimate healthcare claim, do not give up—contact Attorney Scott Glovsky. Scott is a highly experienced Santa Clarita, CA health insurance denial attorney who can help you determine your next steps. At the Law Offices of Scott Glovsky, we are always honest and straightforward with our clients as we help you receive payment for your denied claim. We care about the outcome of your claim, and we will aggressively fight for your rights, your health, and your future. Contact the Law Offices of Scott Glovsky today!